Archive for the ‘Laser vision correction’ Category

Recovering from Laser Vision Correction: Tips and Timeline

Saturday, March 11th, 2017

istock_000018052378_xxxlarge-300x200Let’s imagine that you made the decision to undergo laser vision correction and scheduled your operation with the team at Bochner Eye Institute. As you are making plans for the surgery, you are probably wondering about the recovery period and what you can expect. In this post, our team explains what you need to know about the recovery timeline and how to enjoy a safe and complication-free recovery. (more…)

Over 20 Years of Laser Vision Correction at Bochner Eye Institute

Monday, May 20th, 2013

Laser vision correction has been the most common and successful refractive procedure in North America over the past 2 decades. Clinical outcomes have been excellent when respecting the indications and contraindications of the procedure, utilizing advanced technology, surgical competence, and careful follow-up care. After more than 20 years of performing laser vision correction at the Bochner Eye Institute, this is my top list of factors to ensure outstanding patient outcomes:

1.    Rule out keratoconus and pellucid marginal degeneration (PPMD)
LASIK is a contraindication in eyes with keratoconus and PPMD. Creating a flap in a structurally weak cornea can lead to cornea ectasia. There are many clinical signs of keratoconus and PPMD but the most helpful involve topographical and pachymetry imaging utilizing Pentacam technology. Findings of clinical value include: A. Inferior to superior steepening of greater than 1.6 D; B. Central steepening of 48 D or greater; C. Elevation of posterior cornea of 17 microns or greater; and D. Area of corneal thinning that corresponds to the area of anterior and posterior corneal elevation.

2.    Rule out dry eyes
Dry eye syndrome especially with a superficial punctate keratopathy can delay the visual recovery. Patients with severe dry eyes should not undergo laser vision correction. Patients with mild to moderate dry eyes if treated aggressively preoperatively may be satisfactory candidates for LASIK. Dry eye treatments may include preservative-free artificial tears, oral omega fatty acids, lubricating gels or ointments, Restasis drops, hot compresses to the lids if plugged meibomian glands, or the Lipiflow procedure. Bochner Eye established a Dry Eye Clinic to try to rehabilitate patients and enhance their comfort and visual function.

3.    Femtosecond flap creation
Femtosecond technology has revolutionized the safety of LASIK. The creation of a thin flap that has the same thickness in the centre and periphery reduces the risk of serious complications. Unfortunately discount laser centres continue to utilize a mechanical microkeratome that exposes patients to significantly higher risks. Femtosecond lasers have eliminated the risks associated with mechanical micrkeratomes, which include: button holes, free flaps without a hinge, partial flaps, and irregular flaps.

4.    Surgical competence
Although excimer lasers and the creation of femtosecond flaps have added some automation to the procedure there are many steps that require surgical care. A skilled surgeon will insure proper centration of the corneal flap, a dry corneal bed prior to and during the excimer ablation, satisfactory patient fixation during the excimer ablation, minimal irrigation beneath the flap, and careful repositioning of the corneal flap.

5.    Postoperative care
Although complications are uncommon using advanced technology, the identification of any early complications and proper management can insure an excellent outcome. Most early complications include visually significant striae, diffuse lamellar keratitis, and an epithelial defect. The rare complications are microbial keratitis and corneal ectasia. If the refractive outcome is not satisfactory then an enhancement can be performed. It is typically best to wait at least 4 months for an enhancement to ensure refractive stability.

6.    Maintenance and Calibration of Equipment
A laser centre must insure proper calibration and maintenance of all the equipment. Excimer laser and femtosecond technology require frequent maintenance checks to be sure optimal function. A dedicated technical staff that is experienced with daily calibration of the equipment and ensures regular maintenance is critical to achieving outstanding results.

7.    Communication between the surgeon and comanging doctor
Communication between the surgeon and comanging doctor about any patient concerns or general education concepts is vital for optimal care. At the Bochner Eye Institute, communication can be accomplished with a phone call, email, or fax.

8.    Ability to customize excimer laser ablations using either topographically-linked, wavefront-guided, or wavefront-optimized techniques
The surgeon should be able to choose the right technology for the right patient to achieve the best possible outcome. Technology continues to advance with more sophisticated treatment options. When patients have any corneal irregularity, a topographically-linked ablation is the treatment of choice to smooth the corneal surface. Eight Pentacam images, representing 20,000 data points per image, are transferred to the excimer laser system and a customized laser ablation is performed. In addition, we now have the ability to centre the excimer ablation over the line-of sight and not the centre of the pupil using a topographically-linked ablation. We all recognize that a patient’s refractive error is aligned with the line-of sight, which is not necessarily the centre of the pupil. By performing the laser ablation over the line-of sight we can enhance the refractive accuracy especially in hyperopic patients.

9.    Presbyopic Considerations
Understanding the patient’s lifestyle can allow one to customize the treatment. There are many options for the correction of presbyopia including reading glasses, monovision LASIK, KAMRA or other corneal inlays, monovision with an aspheric implant, or multifocal implant with refractive lens exchange. There are advantages and disadvantages to each option. Factors that can influence a presbyopic decision include the value of stereoscopic distance vision and/or stereoscopic near vision, early crystalline lens changes, requirements of night time driving, and personality traits that can play a role in dealing with any visual imperfections. At Bochner we explore all the presbyopic options with our patients before a decision is made for final treatment.

10.    Realistic Patient Expectations
Although over 98% of patients undergoing LASIK at Bochner have excellent  uncorrected visual acuity there are some patients that may require an enhancement. As we all know, laser surgery is performed on human tissue and not on a piece of plastic. As a consequence there can be an individual variation in outcome as a result of the laser interaction with the cornea, as well as a difference in postoperative healing. At the Bochner Eye Institute, laser enhancements are performed at no charge. This life-time warranty has been our policy for over 20 years.

By Dr Raymond Stein

Bochner Eye Institute Offering Laser Cataract Surgery in Toronto

Wednesday, September 12th, 2012

The most significant advance in cataract surgery in the past 50 years has been the development of laser cataract surgery. We are proud to be the first centre in Canada to offer laser cataract surgery with the CatalysTM precision laser system. Laser cataract surgery automates many of the steps that were previously performed manually with a forceps, needle, or blade. The precision of the laser allows for enhanced safety and outcomes.

Bladeless Laser Cataract Surgery has a number of unique advantages over traditional cataract Surgery:

  1. Better self-sealing incisions with less chance of leakage.
    The laser precisely creates all the necessary incisions in the cornea. Unlike with a hand-held blade used in traditional surgery, the laser incisions have a unique architecture and a more precise width that allow them to seal better.Masket S, Saraba M. Femtosecond laser-assisted cataract incisions: architectural stability and reproducibility. J Cat & Refract Surg 2010:36:1048-1051
  2. Improved reduction of astigmatism and enhanced comfort.
    The laser incisions to reduce astigmatism are created at a precise location, length, depth, and angle based on intraoperative imaging using an OCT (optical coherence tomography). An OCT provides higher resolution than an MRI. The incisions are created below the corneal epithelium, which provides enhanced comfort. Limbal relaxing incisions with traditional surgery are performed with a hand-held blade.Kymionis G, Yoo S, Ide T, Culbertson W, Femtosecond-assisted astigmatic keratotomy J Cat & Refract Surg. 2010:35(1):11-13
  3. Potential for better refractive outcome and quality of vision
    The laser can create a perfectly round central opening in the anterior capsule of a specific size. The capsule opening can be centered over the visual axis. The intraocular lens is held in place with the remaining capsule. With a more precise capsule opening there is less chance that the intraocular implant will vault forward, backward, or be tilted. This has been shown to result in better quality of vision with a reduction in higher-order aberrations.Kránitz, K; Takacs, A ; Femtosecond Laser Capsulotomy and Manual Capsulorrhexis and Effects on Intraocular Lens Centration. J Refract Surg. 2011;27(8):558-563.
  4. Potential for clearer vision early postoperatively.

    The laser is used to fragment or break the cataract into small segments before being liquefied with ultrasound and removed with aspiration. The laser fragmentation results in a dramatic reduction in ultrasound energy by approximately 96%. This reduced energy is safer for the long-term health of the corneal endothelial cells and may lead to clearer vision in the early postoperative period.Naranjo-Tackman R. How a femtosceond laser increases safety and precision in cataract surgery. Curr Opin Ophthalmol 2010

Laser cataract surgery is a revolutionary cataracts treatment that is safe and precise. The advent of this technology has made it possible for more patients to seek treatment and obtain clear vision, including patients with astigmatism. To learn more about laser cataract surgery or in Toronto, contact Raymond Stein MD at Bochner Eye Institute to schedule a comprehensive consultation with an experienced laser vision correction surgeon.

Laser Blended Vision or Micro-Monovision – Raymond Stein, MD

Thursday, April 7th, 2011

This laser correction technique was developed by Dr Dan Reinstein of London, England in 2005. It is another method of monovision. Reading vision is enhanced in only one eye. The technique induces negative spherical aberration, a higher-order aberration, to increase the depth of focus. This results in enhanced reading with a slight decrease in distance acuity. Dr.

Raymond Stein reviewed this method of correction at the University of Toronto, Walter Wright meeting in 2009. We have offered this technique at Bochner since 2007. Presbyopic patients that tolerate traditional monovision are the best candidates for laser blended vision.

A detailed video summary of Laser Blended Vision by Dr Reinstein is available at www.youtube.com/watch?v=JVGnb6ZIzLk.

To learn more about Dr. Raymond Stein and Bochner Eye Institute, please call (416) 960-2020.

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Femtosecond Laser for Creation of LASIK Flap

Friday, January 21st, 2011

Dr Raymond Stein of the Bochner Eye Institute wrote the following clinical update. We hope you find it of interest.

Many reports have demonstrated the superiority of Femtosecond laser created flaps over a microkeratome blade: increased flap thickness accuracy,1,2,3 greater consistency of flap thickness,4,5 the elimination of buttonhole flaps,1,6 decreased epithelial injury,4, 7,  greater flap adhesion strength, 8 ,faster visual recovery and better uncorrected visual acuity,8,9 improved contrast sensitivity,10 better refractive astigmatic neutrality,5 decreased higher order aberrations,11 and decreased corneal insensitivity and tear function compromises.12,13

The laser flap has a uniform or planar thickness. A blade creates a meniscus flap which results in a thinner flap in the centre and thicker in the periphery. This can lead to one of the most dreaded LASIK complications of a button-hole. This can result in loss of best-corrected vision from irregular astigmatism or scar tissue. When we acquired a Femtosecond laser 4 years ago we thought initially we would offer both the Femtosecond and blade technologies. After doing our first cases we quickly sold our microkeratome. All prospective laser patients should be aware that the Femtosecond laser provides the most technologically advanced and safest procedure.

Why would some laser centres today offer inferior technology? The answer is very clear – cost. The purchase of a Femtosecond laser costs around $500,000, there is an annual maintenance fee of around $70,000, and a disposable cost (suction ring) of approximately $200 per eye. A microkeratome can be purchased for $25,000 or less, there are no annual maintenance fees, and the cost of a blade is around $50 for both eyes. So you can see from a cost point of view there are significant savings to a laser centre to offer inferior technology with a microkeratome.

Femtosecond technology continues to advance. At the Bochner Eye Institute we acquired the first IFS laser in Canada, which has a speed of 150 KHz. This is 2.5 times faster than the previous laser technology. This results in the suction ring being on the eye for less time resulting in a more comfortable experience for the patient. In addition the new technology can create a flap edge greater than 100 degrees. This leads to a more stable flap position like a man-hole cover, and a lower incidence of epithelial ingrowth.

At the Bochner Eye Institute we continue to treat a significant number of eye-care professionals from across Canada and the United States. We feel this is because eye doctors understand leading edge technology and trust our surgical techniques and abilities.

1.Binder PS. Flap dimensions created with the Intralase FS Laser. J Cataract Refract Surg. 2004;30:26-32.

2. Javaloy J, Vidal MT, Abdelrahman AM, Artola A, Alio JL. Confocal microscopy comparison of Intralase femtosecond laser and Moria M2 microkeratome in LASIK. J Cataract Refract Surg. 2007; 23:178-187.

3. Patel SV, Maguire LJ, McLaren W, Hodge DO, Bourne WM. Femtosecond laser versus mechanical microkeratome for LASIK: a randomized controlled study. Am J Ophthalmol. 2007;114:1482-1490.

4. Kezirian GM, Stonecipher KG. Comparison of the Intralase femtosecond laser and mechanical keratomes for laser in situ keratomileusis. J Cataract Refract Surg. 2004;30:804-811.

5. Talamo JH, Meltzer J, Gardner J. Reproducibility of flap thickness with Intralase FS and Moria LSK-1 and M2 microkeratomes. J Cataract Refract Surg. 2006;22:556-561.

6. Binder PS. One thousand consecutive IntraLase laser in situ keratomileusis flaps. J Cataract Refract Surg. 2006;32:962-969.

7. Duffey RJ. Thin flap laser in situ keratomileusis: flap dimensions with the Moria LSK-One manual microkeratome using the 100-micron head. J Cataract Refract Surg. 2005;31:1159-1162.

8. Knorz MC, Vossmerbaeumer U. Comparison of flap adhesion strength using the Amadeus microkeratome and the IntraLase IFS femtosecond laser in rabbits. J Refract Surg. 2008;24:875-878.

9. Durrie DS, Kezirian GM. Femtosecond laser versus mechanical keratome flaps in wavefront-guided laser in situ keratomileusis: a prospective contralateral eye study. J Cataract Refract Surg. 2005;31:120-126.

10. Tanna M, Schallhorn SC, Hettinger KA. Femtosecond laser versus mechanical microkeratome: a retrospective comparison of visual outcomes at 3 months. J Refract Surg. 2009;25:S668-S671.

11.Montes-Mico R, Rodriguez-Galietero A, Alio JL. Femtosecond laser versus mechanical keratome LASIK for myopia. Ophthalmology. 2007;114:62-68.

12. Tran DB, Sarayba MA, Bor Z, Garufis G, et al. Randomized prospective clinical study comparing induced aberrations with IntraLase and Hansatome flap creation in fellow eyes. J Cataract Refract Surg. 2005;31:97-105.

13. Lim T, Yang S, Kim MJ, Tchah H. Comparison of the IntraLase femtosecond laser and mechanical microkeratome for laser in situ keratomileusis. Am J Ophthalmol. 2006;141:833-839.

14. Barequet IS, Hirsh A, Levinger S. Effect of thin femtosecond LASIK flaps on corneal sensitivity and tear function. J Refract Surg. 2008;24:897-902.

Raymond Stein MD Video – Toronto LASER Eye Surgery- Bochner Eye Institute

Wednesday, October 20th, 2010
Raymond Stein MD - View video click here

Raymond Stein MD - View video click here

To learn more, watch a video about Dr. Raymond Stein

Raymond Stein talks about his past 20 years of Laser Vision Correction- As seen in EyeWorld

Wednesday, October 20th, 2010

“Over the past 20 years at the Bochner Eye Institute, every day has been an exciting day for our patients, our staff, and our surgeons. Patients’ lives are enhanced with a painless, quick, and safe procedure. The most common regret that patients tell us is they wish they had the surgery when they were younger. Today patients who have laser surgery range in age from 18-65 years. In the early days of laser vision correction, it was primarily the risk takers who underwent the procedure. Skydivers, bungee jumpers, and motorcycle riders were commonplace. Today I see a high percentage of chess players, actuaries, accountants, and surgeons who are undergoing the procedure. Many patients don’t have any specific problems with their glasses or contact lenses but want to be free to live their life without any optical aids.” from EyeWorld

Raymond Stein as seen in EyeWorld

Raymond Stein MD as seen in EyeWorld at recent ASCRS meeting in Chicago

More about Raymond Stein

Lasik in Toronto Reviews Bochner Eye Insitute

Lasik in Toronto
40 Prince Arthur Avenue
Toronto, ON M5R 1A9
(416) 960-2020

Laser Vision Correction: A New Age

Monday, June 28th, 2010

Raymond Stein, MD, FRCSC

raymond-stein-torontoIf you wear contact lenses or glasses imagine waking up to a life of clear vision. The ability to drive, walk, run, go to the theater, participate in sports, all without any optical aids. There are practical reasons such as improved peripheral vision compared to glasses (especially important when driving) or improved safety compared to contact lenses with a lower risk of corneal infections. The United States military has encouraged laser vision correction for its combat soldiers in Iraq and Afghanistan to enhance visual performance.

My grandfather Dr Maxwell Bochner founded the Bochner Eye Institute in 1929. This past year we celebrated our 80th anniversary as one of the oldest private eye-care facilities in North America. Our goal has always been to provide the best possible care delivered in a kind and compassionate way. In the modern era of high technology we feel it is especially important to carry on the tradition of Dr Bochner of caring for the individual patient.

We have been performing laser eye surgery for the past 19 years at the Bochner Eye Institute. Everyday is an exciting day for our patients, our staff, and our surgeons. Patients’ lives are enhanced with a painless, quick, and safe procedure.  The most common regret that patients tell us is they wish they had the surgery when they were younger. Today patients range in age from 18 to 65 years of age that have laser surgery.

Some patients want to join the police force or become a firefighter and need a certain level of vision without glasses or contacts. Some patients are unable to wear contact lenses because of dryness or solution reactions. Today many patients are not having any specific problems with their glasses or contact lenses but want to be free to live their life without any optical aids.

Many patients ask me if eye doctors are undergoing laser eye surgery. The percentage of eye doctors that have undergone the procedure is greater than that in the general population.  In fact, there have been over 400 eye doctors that have come to the Bochner Eye Institute to have their own eyes treated. Eye doctors have travelled to the Bochner Eye Institute from as far away as Australia, Italy, and India.

Are you a candidate for laser vision correction? All patients need to have a detailed eye evaluation to make sure they are excellent candidates. This comprehensive examination consists of a computerized assessment of vision, a mapping of the corneal surface and thickness, a measurement of the quality and quantity of the tear film, and an evaluation of the intraocular health. At the Bochner Eye Institute we offer an assessment and informative consultation on the procedure, at no charge.

Not all patients are satisfactory candidates for laser eye surgery. In some cases patients may have relatively thin corneas or extremely high prescriptions. At the Bochner Eye Institute we offer all the surgical options for vision correction. In some situations patients can be helped with other procedures such as a refractive lens exchange (replacement of the patient’s lens with an implant), or a phakic implant (insertion of a thin implant in front of the patient’s lens).

bochner-eye-institute-torontoAll surgery is done at the Bochner Eye Institute. The Institute is in a historical building in the Yorkville area in Toronto. There are four floors that houses advanced technology and a dedicated and highly trained staff. In addition to excimer lasers from Germany and California, there are two operating rooms for intraocular surgery. The Ontario College of Physicians and Surgeons have approved the Institute’s operating rooms.

The most advanced technique of LASIK utilizes a femtosecond laser to create a thin flap of tissue. This is a revolutionary technique that offers an unparalleled method of accuracy and safety.   Patients feel a slight amount of pressure but no pain. The second part of the procedure is the reshaping of the cornea with the excimer laser. The LASIK flap is gently lifted and the laser is activated to remove a precise amount of tissue on the underlying bed. Usually less than the thickness of a hair is removed. The flap is repositioned over the bed and it adheres in a few minutes. This painless and quick procedure allows for the correction of nearsightedness, farsightedness, or astigmatism.

Patients are often concerned that if they move their eye during the procedure it could affect the outcome. Fortunately the most sophisticated lasers are equipped with accurate eye trackers that monitor the position of the eye and allow the laser pulses to be delivered to the right spot ensuring an excellent outcome.

Following LASIK eye surgery 99% of patients can drive without glasses the next day. 1% of patients may take a few extra days. Patients are also happy that they can resume their normal activities so quickly after the procedure.  The majority of patients report that their vision during the day or at night without glasses, is better than what they previously experienced with the best pair of contact lenses or glasses.

If Dr. Bochner were alive today he would be proud of the continued tradition of excellence in patient care and innovation. The surgeons of the Institute have published over 35 textbooks to educate eye doctors, family doctors, and patients about a variety of eye disorders and treatments. The surgeons have also received prestigious awards from International and local organizations to recognize their leading accomplishments. I am proud of our history and look forward to the continued tradition of innovation and excellence in patient care. More about Raymond Stein

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